Does Sex Hurt?

This page talks about Vulvar Vestibulitis, one possible cause of painful sex in women.

At some point in their lives, most women will experience some discomfort or pain with intercourse/vaginal penetration. Often, using a lubricant, finding a more comfortable position, or treating an infection can ease this discomfort.

However, if you are still experiencing pain in the entrance of your vagina, you may have vulvar vestibulitis. If you would like to learn more about vulvar vestibulitis or other causes of painful sex, please speak to one of our counsellors or doctors.

What is Vulvar Vestibulitis?

Vulvar Vestibulitis (VV) is a condition that causes burning, stinging, irritation or rawness in the vestibule (the entrance to the vagina). This pain is usually associated with swelling of the glands in the vestibule.

Most women with VV experience pain during vaginal intercourse (or attempted intercourse), and on the insertion of tampons. Some women also find riding a bicycle, horseback riding, or jogging painful. In severe cases, walking and sitting may also be painful. The duration of symptoms may be a few weeks to several years.

According to the National Institutes of Health in the United States, up to 15 per cent of women in most gynecological practices have dyspareunia (painful intercourse) and it is believed that VV is the most frequent cause.

What causes VV?

The cause of VV is not known for certain. However, there are some theories regarding its origin. VV seems to occur following a severe yeast infection or trauma to the vestibular area (such as childbirth, surgery, or assault).

VV sufferers often have chronic yeast infections that do not respond to common yeast therapies. Some women have VV and interstitial cystitis (burning and urgency upon urination) at the same time and some research has been done to find out if there is a correlation between the two conditions.

There is also a belief among some researchers that VV is associated with fibromyalgia, a muscle pain disorder. In the past, VV has been linked with HPV (the human papilloma virus), HSV (the herpes virus), high amounts of calcium oxalates in the urine (calcium oxalates are components found in many foods), and psychological disorders, but new research has shown no correlation between VV and these conditions.

In short, no definite cause of VV is known and further research needs to be done.

How is VV diagnosed?

More often than not, women have to see many health care practitioners before being correctly diagnosed with VV. This is a process that can take months or even years, as the vagina appears to be “normal” upon inspection and lab tests come back negative as VV is not associated with any STIs.

Women may be told they have a low tolerance for pain or that their pain is caused by vaginismus (an involuntary tightening of the vaginal muscles making it difficult or impossible to insert anything inside the vagina). In many cases, this frequent misdiagnosis leaves women feeling frustrated and humiliated.

Doctors who are properly informed about VV will first rule out any infections that may be causing the pain. It is also important to rule out dermatitis, an allergic reaction to a chemical such as a harsh soap or feminine hygiene product. They will then be able to make a clinical diagnosis of VV based on the following three criteria:

Pain on attempted vaginal entry.

Pain when Q-tip is applied to vestibule (pain is usually most severe at base of hymen and in back third of vestibule).

Redness in vestibular area (many women with VV will not have redness in this area).

The doctor may also perform a colposcopy (an exam that uses a powerful microscope) on the patient for a closer inspection of the vestibular area.

Once diagnosed, it is not unusual for women to feel a sense of relief and validation. However, even after diagnosis, many women are still left feeling frustrated and discouraged in their search for answers and effective treatment.

How is VV treated?

There is currently no standard treatment for VV. However, there are many different treatment approaches with varying degrees of success. The following are some treatment options that your VV specialist may discuss with you:

Applying topical anesthetic (numbing) creams several minutes before intercourse can temporarily relieve pain during intercourse but is not a long-term solution. Women are also advised to use non-irritating, water-based lubricants during intercourse.

Long-term anti-candida (yeast) treatments used in conjunction with vaginal dilators to desensitize the vestibular areas have shown promising results.

Other doctors prescribe topical estrogen creams, based on the theory that the vestibule may have atrophied due to lack of estrogen (sometimes thought to be caused by low-dose birth control pills).

Another treatment approach that has shown a high degree of success is biofeedback. Some researchers believe that in patients with VV, the muscles of the pelvic floor (the muscles that hold the pelvic organs in place) aren’t functioning properly. Biofeedback works on rehabilitating these muscles.

Acupuncture, homeopathy, and other alternative methods of relieving pain may be of benefit.

As a last resort, some doctors have suggested surgery for their patients to remove some or all of the vestibular area. However, in many cases, relief after surgery is short-lived and the pain that returns is often more severe than before the surgery.

Finally, it is advised that all patients also receive counselling and/or sex therapy as VV can severely impact on a woman’s feelings of self-worth, their emotional comfort around sex and sexuality, and their intimate relationships with partners.

None of the above mentioned treatments are “cures” but most of them have had at least some amount of success. Some women who found penetration impossible prior to treatment are now able to have intercourse with minimal or no pain. The treatment course that is right for each woman should be decided between herself and her VV specialist.

The following is a list of things women can do themselves to help reduce vaginal irritation:

Allow your vagina to “breathe” by:

Wearing white, unbleached cotton underwear

Using 100 per cent cotton menstrual pads or tampons (usually found in health food stores)

Not wearing pantyhose or stockings

Wearing loose-fitting pants

Removing wet bathing suits as soon as possible

Not wearing underwear to bed

Avoid chemical irritations to the vagina by:

Not using harsh or perfumed soaps in the vaginal area (Cetaphil, Pears, and unscented Dove are good alternatives)

Avoiding feminine hygiene sprays, bubble baths, and hot tubs

Using dye and perfume free detergents when washing underwear

Rinsing your vaginal area with lukewarm water after washing, making sure there is no soap residue left

Also avoid exercises that may irritate the vaginal area such as bicycle riding, horseback riding etc.

The emotional impact of VV

Suffering from VV can cause emotional as well as physical pain. Until proper diagnosis, women are sometimes made to feel that the problem is “all in their head” and that their doctors don’t understand, or even believe their discomfort.

While a diagnosis is often helpful, some women are still left feeling overwhelmed, depressed, and isolated. The relentless images of sex and sexuality in the media can be constant reminders of their condition, and many women feel they are “incomplete,” “damaged,” or “not worthy.” Some women have even reported feeling suicidal.

Women are often ashamed of their condition and most suffer in secrecy. This can cause low self-esteem, guilt, emotional and sexual difficulties in relationships, or the reluctance to enter into new relationships. Women who are already in relationships should consider couples counselling, as vestibulitis can lead to a lack of intimacy and can complicate future plans for pregnancy (as some women find intercourse or insemination too painful).

Whether by themselves or with partners, it is very important that women seek counselling in order to help them understand their emotions and how to work through them.

Where should a woman with suspected VV go?

If you think you may have VV, Hassle Free Clinic or your family doctor can refer you to one of the following VV specialists: